Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Pediatric Disorders of Sweating: Treatment Options
Description
This presentation by Tor Schwader, a pediatric dermatologist, discusses various treatment options for pediatric disorders of sweating, particularly hyperhidrosis and hypohidrosis. He highlights the importance of testing, such as the starch-iodide test, to evaluate sweating disorders. Treatments include topical aluminum or zirconium salts that form plugs in sweat ducts, glycopyrrolate lotions, iontophoresis systems, and Botox injections, the latter used off-label in children. The efficacy of these treatments varies, with many requiring ongoing use for the best results. Schwader notes potential side effects such as dry mouth from glycopyrrolate and complications from Botox use. He discusses surgical interventions like sympathectomy, which can lead to compensatory sweating elsewhere. For children who experience anhidrosis due to genetic disorders, management focuses on avoiding heat stress, wearing appropriate clothing, and maintaining hydration. Schwader emphasizes the need for careful monitoring of medications that can induce anhidrosis. Resources like the National Foundation for Ectodermal Dysplasia and various cooling technologies for children with sweating difficulties are also mentioned. Ultimately, he calls for a holistic approach to managing sweating disorders, considering all aspects of patient health and quality of life.
View moreConclusions
- The starch iodide test is an effective method for evaluating hyperhidrosis.
- Patients must be informed that treatment will not change their hereditary sweating conditions, which will return upon treatment cessation.
- Topical aluminum or zirconium salts are effective and are often used as first-line treatments for hyperhidrosis.
- Patients may need to apply topical treatments regularly for continuous effect, especially in warmer months.
- Glycopyrrolate cloths have demonstrated long-term efficacy in reducing sweat production among pediatric patients with primary hyperhidrosis.
- Side effects of glycopyrrolate typically include mild anticholinergic effects which generally resolve after a week.
- Iontophoresis is effective for palmar and plantar hyperhidrosis, with minimal side effects but requires regular sessions for optimum results.
- Botulinum toxin injections are effective for hyperhidrosis, specifically in adults, though their use in pediatric cases is currently off-label.
- Microwave therapy offers a non-surgical option that effectively reduces underarm sweating with high patient satisfaction rates, although side effects can occur.
- Surgical options exist for severe cases of hyperhidrosis, including sympathectomy, which may lead to complications such as compensatory sweating.
- JRS Gordon et al. Update on Pediatric Hyperhidrosis. Dermatologic Therapy v26, p452 2013.
- A A Hebert et al. Long term efficacy and safety of topical glycopyrronium tosylate for treatment of primary axillary hyperhidrosis Pediatric Dermatology 2020; 37: 490-497.
- Pashaei-Marandi A, Assam JH, Arnold A, Lee AG, Siscos SM et al. Use of gloves when applying topical glycopyrronium for treatment of primary axillary hyperhidrosis. J Am Acad Dermatol, 2019 Dec 14. doi: 10.1016/j.jaad.2019.12.021.
- Jeganatha R et al. Interact Cardiovasc Thorac Surg 2008;7:67-70.
- Baumann LS et al. Clin Dermatol 2004;22:60-5.
- Paller AS, Shah PR, Silverio AM, et al. Oral glycopyrrolate as second-line treatment for primary pediatric hyperhidrosis. J Am Acad Dermatol 2012; 67:918 - 923.
- Hong HC et al. Clinical eval of microwave for axillary hyperhidrosis. Derm Surg 2012.
- Lee S. et al. Microwave for hyperhidrosis in Asians. J Cosmet Laser Therapy 2013.
- Glaser DA, et al. Microwave for axillary hyperhidrosis. Derm Surg 2012.
- Ibrahim O, et al. Liposuction compared to Botox. JAAD 2013; 69:88-95.
- Bell, D et al. Predictors of outcomes for endoscopic ... ANZ J Surg 2014;84:68-72.